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This contract is made and
entered into on __________________ (date) by_________________________(herein
called the client) whose address is __________________________________ and _______________________,
(herein called the contractor) whose address is
________________________________________________. In consideration of the
mutual promises in this contract, the parties agree to abide by all the terms
of this contract. It is understood that the contractor is an independent
contractor and not an employee of the client and therefore will be
responsible for all taxes and withholdings. |
_________________________________
Transcriptionist Signature
_________________________________
Client’s Signature
_________________________________
Date
CONTRACT
FOR MEDICAL TRANSCRIPTION SERVICE
SAMPLE 2
JANE SMITH
MEDICAL TRANSCRIPTION SERVICE
PHONE:
1-234-567-8910 FAX: 1-000-123-4567
This agreement entered into
on (DATE)____________________, by and between the Transcriptionist, known as:
Jane Smith, whose address is
__________________, and telephone number is_________________________, and the
Professional client
___________________________and
telephone number is _____________Whereas Transcriptionist desires to contract
with the Professional client to perform said work and/or service, and
Whereas the parties desire
to set forth their contractual and business arrangement(s)
Therefore, this agreement
constitutes the said contractual and business arrangements, and the parities
contract and agree as follows:
The Transcriptionist agrees
to perform, abide by and follow the stipulations listed in the remainder of
this contract.
The transcriptionist is
responsible for providing all equipment and supplies necessary for any work
done, other than supplies given by the professional client (i.e. stationery
indigenous to the professional client). These supplies provided by the transcriptionist,
but not limited to, office equipment (i.e. typewriter, computer, transcription
equipment, etc.) paper, dictionaries and manuals, tools, etc. The
transcriptionist is also responsible for all repairs on her own equipment.
Any supplies that are necessary
from the professional client must be requested well in advance by the
transcriptionist and the transcriptionist is responsible for keeping adequate
supply on hand at all times. This supply must be returned to the professional
client should this contract ever cease.
Any equipment or supplies
loaned by the Professional client to the Transcriptionist must be returned to
the Professional client at the termination of this contract, or final payment
of any payment due will be withheld until said items are returned.
Each professional client’s
pricing is set separately, according to the individual client. Pricing is by
each piece and/or line as set forth in the WORK SCOPE.
Payment for services rendered
is on ______________. (This may be determined by the Professional Client’s
present staff practice). If the Transcriptionist does not turn in invoices by
the dates specified, the Professional client is not responsible to pay by any
set date and pay may be late.
The Transcriptionist must
give a separate billing for each professional client to the Professional
client. Each billing must be typewritten or computer generated and include the
name of the client, the dates of the billing, the pages and specific dates of
work completed and, if applicable, a description of each piece of work
completed, and individual pricing, as well as total. The Transcriptionist must
be prepared to back up each billing with copies of work completed should the
Professional client request any information regarding the services rendered.
Professional client will pay
for any work containing errors. Transcriptionist is responsible to redo all
work containing errors without charge to the professional client or agency. If
the professional client should request a redo of the transcription with minor
editing changes that were not the fault of the Transcriptionist then the
Transcriptionist will provide redo at ½ of the original cost. Fax charge
remains the same for each page faxed each time it is faxed.
Professional client is not
responsible to pay for redo work in the case of power outages or faulty
equipment. It is the responsibility of Transcriptionist to keep equipment in
working order and to provide backup emergency services should a technical
problem occur.
Transcriptionist may not
communicate with Professional client directly regarding billing or pricing
structure or anything other than a question directly applying to the
transcription or work procedures, such as terminology, spelling, etc. unless it
is the policy of the professional client to do so. When communicating with the
Professional client on the above matters, transcriptionist must identify
herself as being the Proprietor of Jane Smith Medical Transcription Service.
The Transcriptionist is
responsible for keeping a complete Work Scope on each client. This Work Scope
is to be given to the Professional Client upon termination originated either by
the Transcriptionist or the Professional Client. The Work Scope must be
typewritten or computer generated, include the Professional client’s name,
address, telephone number, names of contact personnel, list of specific
terminology used by that professional client, and any specialized instructions
for that professional client.
The Transcriptionist is
responsible for keeping one month of work for each client on file for reference
for billing purposes, termination or request of the client for any particular
piece of work. The transcriptionist will also save the work on floppy disc and
on request will supply this to the professional client.
The Transcriptionist is
responsible to make specific arrangements with the management of the
Professional client for the delivery of the workload.
The Transcriptionist is
responsible for providing services for the assigned client at all times during
the duration of this contract. The Transcriptionist is responsible for
notification of any time needed for illness or vacation when this will greatly
affect the operation of the Professional client’s work. There is no back up
coverage with this contract.
The Professional client
expects loyalty, enthusiasm and total support verbally, in action and in deed
from the Transcriptionist at all times.
SPECIAL CONSIDERATION:
Professional client
understands that transcriptionist as a disabled person and works on a part-time
basis.
The logo, name, promotional
material, and advertising associated with the Professional client are exclusively
the property of the Professional client. Unauthorized usage of any stationery
or materials or authorized representation of the Professional client is
strictly prohibited. The Transcriptionist cannot use any name similar to or
representing in any way, shape or form the name, advertising methods and
appearances or practices of the Professional client.
The Transcriptionist must
give no less that a 7-day notice to the Professional client in writing for
termination of this contract. Anything less than a 7 day notice will result in
50% penalty fee payable to the Professional Client and subtracted from the
final payment due to the Transcriptionist.
Before the termination is
effective, Transcriptionist must return all supplies and/or equipment belonging
to or loaned or borrowed from the Professional Client. The Transcriptionist is
also responsible for supplying the Professional client with a copy of all
complete and detailed work scope as specified previously in this contract.
Failure to comply with any portion of this termination stipulation or any
portion of this termination contract may result in withholding of final
payment.
Violation of any part of
this contract can result in immediate termination by the Professional client
without notice. All termination terms other than the 7-day notice would then be
applicable for the Transcriptionist and final check would be held until terms
are complied with.
Professional Client reserves
the right to remove from the Transcriptionist (in the case of a multiple
practice) without any notice. Transcriptionist also agrees that Professional
clients can be dropped at any time due to termination from the client.
The Transcriptionist hereby
agrees to abide by all of the terms and stipulations set forth in pages one
through 5 of this contract and understand each item fully, as signified by
signing below.
The contract will be in
effect from date of the agreement and continue for 6 months at which time a
review will be made.
TRANSCRIPTIONIST:___________________________ DATE__________________
SOCIAL SECURITY NUMBER OF
TRANSCRIPTIONIST: ___________________
PROFESSIONAL CLIENT:
________________________ DATE_______________
Professional client will
compensate Transcriptionist $0.___ per line defined as 65 keystroke or
characters for office or hospital reports transcribed plus any additional
transmittal (fax) fees required to
transmit the reports.
SPECIAL CHARGES:
LOST REPORTS: ½ the original
cost.
STAT WORK: STAT work is
defined as anything requested in 12 hours or less: $.20 per line
TURNAROUND TIME shall be 24
hours unless special arrangements are made.
FAXED REPORTS: No charge
if faxing is done evenings or weekends and is within regional telephone area. Fee for generating report is same as above.
COPIES: $.25 per copy.
SPECIAL DELIVERY: $10.00 for
the delivery *negotiable.
ANY PERSONAL TYPING, such as
curriculum vitae form, medical manuscripts negotiable.
EXHIBIT B- ERRORS AND
OMISSIONS:
I DO NOT CARRY ERRORS AND
OMISSIONS INSURANCE. THAT I DO NOT
ENDORSE COMPUTER-AUTHENTICATED OR ARTIFICIAL SIGNATURES GENERATED BY MEANS
OTHER THAN ACTUAL DICTATING PHYSICIAN’S SIGNATURES. THEREFORE, THE DOCTORS SHOULD
PROOFREAD THE TRANSCRIPTION FOR DOCUMENT CONTENT, ACCURACY AND QUALITY CONTROL.
THIS MEANS THAT THEY WILL ACCEPT THE LIABILITY OF THE TRANSCRIPTION AND I WILL
NOT PURCHASE ERRORS AND OMISSIONS LIABILITY INSURANCE.
By signing this
Nondisclosure Agreement, I indicate my understanding that:
Patients, physicians and
other health care providers furnish confidential information to obtain or carry
out medical services, and medical service information and records are
confidential.
Patients depend on the
providers of medical services to keep patient information confidential. The
provider’s reputation depends on this confidentiality.
If medical information has
been used or disclosed inappropriately, patients or providers who have suffered
loss or injury may seek legal action to recover damages from the person who
used or disclosed the information. Specific violations of patient
confidentiality resulting in economic loss or personal injury to a patient may
be punishable by law.
Any breach of
confidentiality will be considered serious and subject to investigation and
possible discipline, including immediate termination of services. Therefore as
a Transcriptionist contract service provider, I agree that I will not at any
time:
Disclose services given or
information about patients.
Allow anyone else to examine
or copy any records or documents having to do with patients, physicians, or
other health care providers and services.
Independent Contractor
______________________ Date:________________
Transcriptionist’s Social Security
Number: 123-45-6789
EIN :
12-3456789_________________
Professional
Client_________________________________________
Date:________________